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Supplemental material, sj-docx-1-jpx-10.1177_23743735231151532 for A Qualitative Study Exploring Rehabilitant and Informal Caregiver Perspectives of a Challenging Rehabilitation Environment for Geriatric Rehabilitation by Lian M J Tijsen, Els W C Derksen, Wilco P Achterberg and Bianca I Buijck in Journal of Patient Experience

Lian MJ Tijsen,1–3 Els WC Derksen,4 Wilco P Achterberg,1 Bianca I Buijck2,31Department Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands; 2Oktober, Bladel, The Netherlands; 3De Zorgboog, Bakel, The Netherlands; 4Department Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The NetherlandsIntroduction: After hospitalization, 11% of the older patients are referred to rehabilitation facilities. Nowadays, there is a trend to formalize the rehabilitation process for these patients in a Challenging Rehabilitation Environment (CRE). This concept involves the comprehensive organization of care, support and the environment on a rehabilitation ward. However, since literature on the principles of CRE is scarce, this review aimed to explore and describe the principles of CRE.Methods: A search was made in PubMed for relevant literature concerning CRE. Then, articles were hand searched for relevant keywords (ie, task-oriented training, therapy intensity, patient-led therapy, group training), references were identified, and topics categorized.Results: After evaluating 51 articles, 7 main topics of CRE were identified: 1) Therapy time; ie, the level of (physical) activity; the intensity of therapy and activity is related to rehabilitation outcomes, 2) group training; used to increase practice time and can be used to achieve multiple goals (eg, activities of daily living, mobility), 3) patient-regulated exercise; increases the level of self-management and practice time, 4) family participation; may lead to increased practice time and have a positive effect on rehabilitation outcomes, 5) task-oriented training; in addition to therapy, nurses can stimulate rehabilitants to perform meaningful tasks that improve functional outcomes, 6) enriched environment; this challenges rehabilitants to be active in social and physical activities, and 7) team dynamics; shared goals during rehabilitation and good communication in a transdisciplinary team improve the quality of rehabilitation.Discussion: This is the first description of CRE based on literature; however, the included studies discussed rehabilitation mainly after stroke and for few other diagnostic groups.Conclusion: Seven main topics related to CRE were identified that may help patients to improve their rehabilitation outcomes. Further research on the concept and effectivity of CRE is necessary.Keywords: geriatric rehabilitation, postacute care, care process, aging

Context: Choking and accidental falls are common incidents in patients with Huntington’s disease (HD). It is not clear which emotional and cognitive factors contribute to the development of fear of choking (FoC) or fear of falling (FoF). Objective: To explore the relationship between cognition, awareness and anxiety and experiencing FoC or FoF in HD, Parkinson’s disease (PD) and dementia. As the literature on HD is expected to be limited, the study population will be expanded by also looking at PD and dementia, both of which are neurodegenerative diseases that share symptoms and signs with HD. Methods: A systematic review of English, German and Dutch articles using the electronic databases: MEDLINE, Embase, CINAHL and Psychinfo. Only studies describing the influence of cognition, awareness and anxiety on the outcome measures FoF and FoC in patients with HD, PD or dementia were included Results: For HD, no reports were found related to the objective of the study and no studies on FoC were found for PD or dementia. The results of studies addressing FoF in PD and dementia were contradictory as far as the relationship with cognition (PD n=5; dementia n=8) and anxiety (PD n=2) was concerned. No study on FoF in relation to awareness was found in any patient group. Conclusions: Although dysphagia and accidental falls are common symptoms of HD, PD and dementia, data on emotional and cognitive factors and their relationship with FoC and FoF are limited. Available data are inconsistent. Future research focusing specifically on these topics might lead to better insight into the relationship between FoC, FoF and cognitive, emotional and behavioral functioning of patients with these diseases. Better insight in these subjects could result in therapeutic options for patients or guidelines for caregivers, with regard to prevention and coping strategies, to improve quality of care.